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HomeMy Public PortalAbout6237 LOMA AVE_Plumbing__ 7EA6E7 17 B-so APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY III N PA B I COUNTY OF LOS ANGELES PLU WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL INRECEI. ED READY FOR DATEISSUEDISTj21CT NO. GROUP ZONE PERMIT NO. / �v PLUMBER h RA V f Al S IS / �BY D FIRST INSPECTION ADDRESS � u H A.S BUILDING CITY 'TemTEL. NO. Ar. ADDRESS (09 N LIQ,�• C,ry (may COUNTY LOCALITY v Pkr6 CITY Y LICENSE NO EXPIRES NEAREST T PERMIT FEES _ CROSS ST. V N n o !�" � ee� a A p �j NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER /� p' A " I� MAIL WATER CLOSET (TOILET) Q O 50 $ I ADDRESS All, L A M A OR _ I BATH TUB Q O s0 I� CITY TEL. NO. SHOWER Q O 50� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ O 5o I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. KITCHEN SINK Q O 50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q o s0 I ANGELES COUNTY LICENOE, OR I AM THE LEGAL OWNER GAS SYSTEM OF THE RESIDENTIr LPROPERTY DESCRIBED ABOVE. OUTLETS @ 0.501 SIGNATURE OF WATER HEATER Q O 50 I PERMITTEE SLOPSINK @ o so I INPCTION RECORD FLOOR SINK @ O 501 FLOOR DRAIN @ O Sol DISHWASHER @ O Sol DRINKING FOUNTAIN Q O So URINAL @ o 501_ _ ,J HOUSE SEWER Q o 50 I 1 Q _Z MISCELLANEOUS I I . � qtr; %D r,ltl r,; / 0 U APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING 1 GAS PIPING 1 GAS VENT CESSPOOL @ 1 00I CESSPOOL SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( ) Q 1 00 SEWER PERMIT . . I 1 oD GAS TEST UTILIT TOTAL FEE Y CO NOTIFIED I $ I ��^� FINAL 76AGO7 17 a-Bo 0 APPLICATION FOR PERM DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER A� �� RECEIVED BY READY FOR DA E ISSUED / FIRST INSPECTION ADDRESS �D �L N 4y V f �ltJ/dam BUILDING CITY TEL NO. ADDRESS _ COUNTY LOCALITY LICENSE NO EXPIRES NEAREST PERMIT FEES cRoss sr f', NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER �� ) _ I MAIL WATER CLOSET (TOILET) Q O 50 s ADDRESS BATH TUB @ O 50 CITY TEL. NO. SHOWER @ O 501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) Q O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. KITCHEN SINK Q O Sol 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O Sol ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. i GAS SYSTEM OUTLETS Q O 50 SIGNATURE OF ��� f,,/+/ WATER HEATER Q O 50 PERMITTEE �.-- ��y�ttt��� _ �1/��/ SLOP SINK @ o Sol INSPECTION RECORD FLOOR SINK Q 0.50 FLOOR DRAIN @ O 50 DISHWASHER Q O SO DRINKING FOUNTAIN Q O 501 URINAL Q O Sol I „J HOUSESEWERQ O SOI I Q MISCELLANEOUS / i---i O I� I APPROVALS II DATE INSPECTOR'S NAME I� ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL Q 1 OO I CESSPOOL i SEPTIC TANK I SEPTIC TANK DRAIN ( -) PIT ( ) Q 1 00 SEWER PERMIT . . I 1 Oo GAS TEST TOTAL FEEI a I UTILITY CO NOTIFIED `// FINAL MAXIMUM ACCbMPLISH D 8-15-5j 76A667-CE#'817 5-61A}�}.��/P ly' C Op,��p FOR PU MppyGPR W q�I� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING J LOCALITY FOR APPLICANT TO FILL IN CBoss sT. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET 24AIL // BATH TUB ADDRESS6 . CITY TEL.No. G '? SHOWER CONTRACTO I LAVATORY SRiS ADD RE DISHWASHER CITY TEL. N . CONTHA STATE COUNTY LAUNDRY,TIIB HEGISfBA7iON NO. - COUNTY CLOTHES WASHER DISTRICT NO. GROUP ZONE PR SEED BY WATER HEATER 0 GAS SYSTEM INDUSTRIAL WASTE APPROVAL � INSPECTION RECORD 0 F- U W a an z ca $1.00 PER ITEM OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING i 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER i IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL NER OF THE ABOVE DESCRIBED RESIDENT PERTY. UTILITY CO NOTIFIED SIGNATURE - OF PERM ITTEE— (rte! A,I FINAL dd P VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R ' --0 7''8,O-t ,UI 2�6 5 A 305.0, � � l 76A667-CE#817 5-61APN FOR PLUMBING, PERMIT COUNTY OF LOS ANGELES ^ r LJ DEPARTMENT OF COUNTY ENGWEER BUILDING AND SAFETY DMSION ;BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS b237 N. Loma WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILL IN CROSS ST. y NUMBER FIXTURE OR ITEM OWNER A. J. Doran WATER CLOS bL%MADDRESS623? N. Roma BATH TUB SHOWER CITY Tem 1 e City TEL NO. CONTRACTOR General Installation Co. LAVATORY srrr>i ADDRESS 6558 west Blvd. DISHWASHER CITY Los Angeles TEL NO, PL 3-2541 TE LAUNDRY TUB REGISTRATIONS EGIIS' CONTRACTOR' AATIONSNO. C-36 151839 787 COUNTY CLOTHES WASHERSTRICT NO. GROUP ZONE SED BY WATER HEATER4-0 /•,I per, GAS SYSTEM IIID O WASTE APPROVAL V INSPECTION RECORD BC O a- U Lu O. s o ' O $1.00 PER TEEM OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING a GAS PIPING ( n_ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ,o f A PLUMBING. r ! I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES J 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I I CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE GAS TEST DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED SIGNATURE OF PERMITTE FINALJk t r VALIDATION ROBERT A.•WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R �►'. r' IJ 5 2 5 0 3 .51; l W(4kERS' COMPENSATION DECLARATION APPUCAMll`Cl FOR PL141MONG PERMPT f r, I hereby affirm that I have a certificate of consent to self 76A667A insufe, pr a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a cer(rified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING ARID SAFETY ' Poficy•No Company ❑ Certified copy is Thereby furnished nn 2 /� El FOR APPLICANT TO FILL IN(PRINT OR TYPE) 7' Jur •LOM A Certified copy is filed with the county building inspec- 3 ADDRESS �L tion.deportment NUMBER FIXTURE OR ITEM rr FEELOCALITY Date Applicant + WATER CLOSET v NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB S CROSS ST LaN,D 0 C- COMPENSATION INSURANCE SHOWER OWNER 5,41_ iIADv,�f, FIC�IC�S (This section need not be completed if the work involved by MAIL //►� the permit is for one hundred dollars ($100)or less.) 4 LAVATORY v 0 ADDRESS b-1 37 N• LOr�/Z I certify that in the performance of the work for which this permit is issued, I shall mot employ any person in any manner SINK• CITY / C� TEL NO so as to become subject to the Workers' omp nsotion La s DISHWASHER C o�- / p CONTRACTOR ©wn/E� Date—�V'O ?Apphcont 1 CLOTHES WASHER ADDRESS J NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO ' LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked I WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO' PRO/29SYD BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM Z OUTLETS ( (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (� and Professions Code,and my license is In full force and effect 5 PER SYSTEM FINAL / VALIDATIO DAT ! ai License Number Lic Class 0 FINAL U Contractor Date BY ❑ 0 I am exempt under Sec 0 U B 8P C for this reason W Plan check fee i1 Date Signature PLUMBING PERMIT ISSUING FEE$ 1 16130 TOTAL FEE ISO �6 5�4 A Z — � '-` #,0,00005 Plan check applicant SINGLE FAMILY ' HOME OWNER-BUILDER DECLARATION Name . . , I 5250 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address 1.0,0 0 5 2 5&0 Professions Code) City Tel No p 2 2 6 j'$7 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby offirrri that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, Civ C ) Lender's Name Lender's Address I certify that I have read this application and state that the D above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m ntione property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date